Claim total
$98.20
base $93.39 · payer covered $48.20
The visit
- Class
- Ambulatory
- Code
- 185349003
- Reason
- diagnosis concept Gingivitis66383009
- Start
- 2025-11-27
- Stop
- 2025-11-27
The parties
- Patient
- patient Santa Antonina Bernier
- Provider
- provider Theo Rutherford
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
051f1153-ae45-1425-38df-fa76322cd628